Practices Of Directors Research Articles

Работы П. Г. Чеснокова 1903 и 1912 годов о церковных хорах и регентской деятельности

The article reveals the main ideas of the early works of the outstanding composer and choir director Pavel Chesnokov on church choirs and practice of the choir directors, which he himself considered the forerunners of his main work in the field of choral science, the book “The Choir and How to Direct It”. The publication of this work in 2023 in its original edition, created for the choir directors, made it possible to trace the evolution of Chesnokov's views on the organization of choral work. The works “Thoughts on the Affairs of an Amateur Choir” (1903) and “Notes of the Choir Director” (1912), whose autographs are stored in the Russian National Museum of Music, have never been published before. They are of great interest as documents depicting not only the process of creating a book, but also, in general, revealing the diverse context of the choir director's practice at the beginning of the 20th century. The article reveals cross-cutting themes that are present to some extent in all of Chesnokov's works, some “parallel places” in the texts are presented. In the work “Thoughts on the affairs of an amateur choir” P. G. Chesnokov defines the principles of organizing the choir, the goals and objectives of the forthcoming work: the need for theoretical studies, the development of a new modern repertoire of church singing, primarily the works of the Moscow Synodal School. In early works, three main qualities of choral sonority have already been formulated: ensemble, structure and nuances, but there is no detailing of working methods. Acquaintance with the early works makes it possible to realize what huge steps Chesnokov took in developing and deepening the problems of choral studies during the preparation of the book “The Choir and How to Direct It”.

Medical Director Practice of Advising Increased Dietary Protein Intake in Hemodialysis Patients With Hyperphosphatemia: Associations With Mortality in the Dialysis Outcomes and Practice Patterns Study

Patients undergoing hemodialysis (HD) may have poor nutritional status and hyperphosphatemia. Nephrologists sometimes manage hyperphosphatemia by prescribing phosphate binders and/or recommending restriction of dietary phosphate including protein-rich foods; the later may, however, adversely affect nutritional status. The analysis includes 8805 HD patients on dialysis ≥ 120 days in 12 countries in Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 4 (2009-2011), from 248 facilities. The primary exposure variable was response to the following question: "For patients with serum albumin 3.0 g/dL and phosphate 6.0 mg/dL, do you recommend to (A) increase or (B) decrease/no change in dietary protein intake (DPI)?". The association between medical director's practice of recommending an increase in DPI and all-cause mortality was analyzed with Cox regression adjusted for potential confounders. Linear and logistic regressions were used to model the cross-sectional associations between DPI advice practice and intermediate markers of patient nutrition. Median follow-up was 1.6 years. In the case scenario, 91% of medical directors in North America had a practice of recommending DPI increase compared to 58% in Europe (range = 36%-83% across 7 countries) and 56% in Japan. The practice of advising DPI increase was weakly associated with lower mortality [HR (95% CI): 0.88 (0.76-1.02)]. The association tended to be stronger in patients with age 70+ years [HR (95% CI): 0.82 (0.69-0.97), P = .12 for interaction]. The practice of advising DPI increase was associated with 0.276 mg/dL higher serum creatinine levels (95% CI: 0.033-0.520) after adjustment for case mix. Medical director's practice of recommending an increase in DPI for HD patients with low albumin and high phosphate levels was associated with higher serum creatinine levels and potentially lower all-cause mortality. To recommend protein intake liberalization in parallel with phosphate management by physicians may be a critical practice for better nutritional status and outcomes in HD patients.